Josie is a badass, Jo Olson is a big damned hero (I can't help but imagine the death threats etc etc she'll get in the wake of this program), and Josie's parents, especially her mom, make my heart warm. Bravo. :)
posted by Drexen at 2:49 AM on May 24, 2013 [4 favorites]

So many feels.

(Incidently, the Youtube user who uploaded this has more documentaries about trans people on their channel.)
posted by MartinWisse at 3:00 AM on May 24, 2013

Amazing parents, amazing kid. At her age I seriously doubt I was more sentient than a jar of snot and this girl was facing serious gender issues and transitioning? Respect.
posted by Foci for Analysis at 4:38 AM on May 24, 2013

Am I a bad person for thinking that major life-altering elective medical procedures should be put off until the patient reaches the age of majority if at all possible?

Am I worse person for thinking that parents should be supportive of their child's gender identity feelings in all cases but should remain open to the idea (and even hopeful) that trans identification at this age is just a phase? Transitioning is hard.
posted by 256 at 4:53 AM on May 24, 2013 [12 favorites]

Wow, what a wonderful family.

256, for sure, lots of children who gender non-conform end up keeping their birth gender. But when a child is so desperate that she resorts to self-surgery, we're probably not talking about that instance.
posted by roomthreeseventeen at 4:57 AM on May 24, 2013 [1 favorite]

Transitioning is hard, but also time sensitive. Waiting until the age of majority means dealing with the indelible changes of puberty.

It's a complicated medical issue and I think it's really counterproductive when we discount both the agency of the child and the wisdom of their doctors to figure out the best possible course of action for each patient.
posted by lydhre at 5:02 AM on May 24, 2013 [10 favorites]

Am I a bad person for thinking that major life-altering elective medical procedures should be put off until the patient reaches the age of majority if at all possible?

Okay, look, hormone blockers are 'life-altering' inasmuch as anything you experience as a child is life-altering. As far as anyone knows, there are no foreseeable long term ill effects from their use. (The studies haven't really been done in trans kids, afaik, but in kids with early puberty, which is the main use of these drugs.)

We also know that transitioning has generally good outcomes and preventing people from transitioning has generally not good outcomes, so precisely how 'elective' it is pretty questionable. And, really, you don't think parents start by assuming their kid's gender is a phase, realise it's not and then go 'oh shit, we'd better figure out what we're going to do to support our kid'?
posted by hoyland at 5:02 AM on May 24, 2013 [14 favorites]

It's a very tough issue, because we're dealing with someone who is nowhere near the age of consent for ... damn near anything, and yet we're approving massive physiological alterations on the basis of their consent.

OT1H, the parents are saintly defenders of the child's best interests as they see those interests, as opposed to simply deciding a path for the child without their input (which is folly).

OTOH, it's a mere child... do we have any tangible, data-driven knowledge of how likely these feelings are to persist to adulthood? (Spare the anecdata, please; I'm sure that many trans people have felt that way as long as they remember, but what about the opposite: how many children change their minds?)
posted by IAmBroom at 5:19 AM on May 24, 2013 [6 favorites]

It's the data that most kids who go on the blockers don't go off them, combined with the data that 80% of kids who experience serious gender dysphoria before puberty come to identify with their birth gender following puberty that concerns me.

Having read up on blockers a bit more, I am less uncomfortable with this, though I would still consider infertility a "long term ill effect."

And, yes, I'm sure that most parents do assume that this is just a phase at first. And, certainly, I'd rather have every parent of a trans child behave like the parents in this story if that meant no more of the more common reaction (trying to beat it out of them).

I just think that if this was my child, I would be trying to find every possible non-medical way to support them, while continuing to hope that puberty, experience, and time would resolve their gender dysphoria naturally. That said, the more I think about how hard it must be to see a child struggling this much, the more I just don't know what I would actually do in these parents' shoes.

I disagree with their decision from a distance, but I don't judge them. They obviously love their kid.
posted by 256 at 5:21 AM on May 24, 2013 [4 favorites]

As shown in the video, you can't just get hormone blockers. It's not just the child's decision, or just the parent's. A physician is the one who makes the call.
posted by roomthreeseventeen at 5:23 AM on May 24, 2013 [1 favorite]

The child and parents still have to decide whether or not to administer them.

And the medical community is split on whether prescribing these blockers for gender dysphoria is ever a good idea. I don't think this is an issue where you need to have a medical degree to have an informed opinion.
posted by 256 at 5:26 AM on May 24, 2013 [1 favorite]

It's the data that most kids who go on the blockers don't go off them, combined with the data that 80% of kids who experience serious gender dysphoria before puberty come to identify with their birth gender following puberty that concerns me.

The overwhelming majority of children with gender dysphoria don't come anywhere near transitioning or hormone blockers, which is why you see those numbers. Hormone blockers are a possibility for a subset of the other 20%, basically. (And, uh, 'most kids who go on the blockers don't go off them' is a wild misunderstanding of how transitioning works.)

I disagree with their decision from a distance, but I don't judge them. They obviously love their kid.

Sounds like you're judging when you're telling us what you'd do with your hypothetical child.
posted by hoyland at 5:28 AM on May 24, 2013 [4 favorites]

I have an actual child. He's two and as far as anyone can tell, identifies with his assigned sex at birth. If he experiences gender dysphoria in childhood and identifies as female, I'd absolutely go down the road of delaying puberty in order to transition rather than allowing her to continue going through life in psychological pain. Infertility is an insignificant concern to me compared to the rates of suicide among trans* teens.

(Reading the thread, but having time to watch a 20min video might take me all day.)
posted by sonika at 5:33 AM on May 24, 2013 [17 favorites]

And the medical community is split on whether prescribing these blockers for gender dysphoria is ever a good idea. I don't think this is an issue where you need to have a medical degree to have an informed opinion.

Perhaps you want to read the Standards of Care and see what people with actual qualifications think? Searching for 'suppression' should take you to the right bit. In particular, note the criteria for puberty suppression.

I kind of hate that I always end up appealing to the SOC in this situation, as if it's the word of God, but nuance is apparently too complicated.
posted by hoyland at 5:34 AM on May 24, 2013 [4 favorites]

If the parents alone can't make the decision, and the parents plus their physician can't make the decision, who should be able to make the decision? Would it be better if there were a board of doctors? Of lay people? A special state authority?

This is a serious question: many parents are called upon to make serious medical decisions on behalf of their children, and we generally defer to their judgment. Why is this case different, and what other mechanism would you impose?
posted by Joe in Australia at 5:34 AM on May 24, 2013 [6 favorites]

Well, I guess it's technically judging to look at any decision and consider how you would do things differently, but I mean that I'm not judging them negatively as parents or people for making this decision differently than how I expect I would.

On the subject of transitioning, my understanding was that one took the blockers until they were 16 or 18 and then (assuming they continued to transition) began a more serious regime of hormone therapy with the net effect of delaying puberty permanently. Am I mistaken? (I know I very well might be)

And my children are not hypothetical.

And Annika: FUD is a term usually reserved for trying to use scare tactics to suppress actual conversation, which is strange because it seems that your comment is the only instance of that so far.
posted by 256 at 5:37 AM on May 24, 2013 [2 favorites]

the hand that dispenses hormone-blocking pills, is the same one that surgically reassigns unacceptable genitalia. be careful what you wish for.
posted by ennui.bz at 5:37 AM on May 24, 2013

Am I mistaken?

Once a trans girl starts taking estrogen, that's not delaying puberty anymore, at 13 or 15 or whatever. She will go through female puberty as best as her body can.
posted by roomthreeseventeen at 5:39 AM on May 24, 2013 [2 favorites]

Can we just really think about what we're saying?

Option one, is that the child goes on hormone blockers. Long term side-effect, possible infertility. This is done at the child's request and need. The child may change their mind, and blame their parents/physician for allowing this. The parents/physician say "You know exactly how unhappy/miserable/depressed/dysphoric you were. We were doing the best we could under the circumstances.

Option two, is that the child is refused hormone blockers. The child goes through puberty, permanently (life-altering) changing the child's body in numerous different ways. The child turns out to be a 'true transsexual' (as my insurance likes to call it). The child becomes more depressed/dysphoric/etc. The child is finally at the right to make their own decisions. They jump through more hoops to get on hormone's for their hormone replacement therapy. The hormone's help as much as they can, but cannot change any of the permanent changes that puberty did to them. They have to live the rest of their life dealing with these unwanted changes. They are more dysphoric. There is more work required for them to do to be happy with themselves, that could have been avoided if you had taken the child's needs into account in the first place.

Children may be children, but they are still people. They still have rights. They still have things like gender and sexuality, no matter how much we want to say these things don't appear til puberty.

_{Haven't watched the video. Read the comments. Saying this as a trans person who wishes she had had this option as a child.}
posted by trogdole at 5:40 AM on May 24, 2013 [26 favorites]

Joe: To be clear, I think that parent+child+physician is exactly the team that should be required and authorized to make this decision. I certainly don't feel that there should be any additional legal hurdles in place.
posted by 256 at 5:56 AM on May 24, 2013

the hand that dispenses hormone-blocking pills, is the same one that surgically reassigns unacceptable genitalia. be careful what you wish for.

I'm not sure I understand. The hormone blockers are being given to a child who can, at the very least, express an opinion, and in this case (and many others) are given at the child's request. Surgical correction of ambiguous genitalia is done on infants. And it's irreversible.
posted by rtha at 5:58 AM on May 24, 2013 [3 favorites]

the hand that dispenses hormone-blocking pills, is the same one that surgically reassigns unacceptable genitalia. be careful what you wish for.

As in, this hand is just all for making sure people fit in a box, regardless of it's M or F? Because in some situations that is bad, yes. But this does not seem to be one of them.
posted by trogdole at 6:07 AM on May 24, 2013

OTOH, it's a mere child... do we have any tangible, data-driven knowledge of how likely these feelings are to persist to adulthood? (Spare the anecdata, please; I'm sure that many trans people have felt that way as long as they remember, but what about the opposite: how many children change their minds?)

Last year, I attended the TransHealth conference and my partner and I went to a presentation given by doctors and psychologists who work extensively with gender non-conforming kids. One of the doctors gave some statistics about the percentage of kids who identify as the opposite gender as young children who actually stick with that identification into adulthood. I'm thinking really hard here not to screw this up, and take anything I say with a little grain of salt. I haven't been able to find an on-line source for this.

If I recall correctly, the doctor said that about 80% of male-bodied children who identify as female or exhibit feminine behavior as young children actually choose to live as women post-puberty. The number is lower for female-bodied children who identify as male for some period of time; maybe about 50%? The theory is that it is so much more socially acceptable for girls to do things like wear boys' clothes and so on that a female-bodied child can be only moderately motivated and still be able to explore this aspect of herself, while the social cost is so much greater for male-bodied kids who want to act or dress like girls that that child has to really want it if they're going ot do it.

One reasonably common outcome, they said, is that female-bodied kids who think they might be boys become aware at some point that lesbians exist, and given that option, realize that that's what going on for them, instead.
posted by not that girl at 7:11 AM on May 24, 2013 [12 favorites]

I just think that if this was my child, I would be trying to find every possible non-medical way to support them, while continuing to hope that puberty, experience, and time would resolve their gender dysphoria naturally. That said, the more I think about how hard it must be to see a child struggling this much, the more I just don't know what I would actually do in these parents' shoes.

Going through puberty as the "wrong" sex can have devastating lifelong consequences. A person who goes through male puberty but identifies as female may grow very tall, develop broad shoulders, develop a deep voice, grow heavy facial hair, and so on. These things are difficult-to-impossible to reverse and may make it difficult-to-impossible for the person to live comfortably in her chosen gender when she grows up (and by "live comfortably" I mean without always being the subject of funny looks, rude questions, and harassment). A person who identifies as male but goes through puberty as a female will grow breasts, for instance, and be more slight in build. My five-year-old female-bodied son was already worrying at age 4 about growing breasts some day. That's pretty heartbreaking, let me tell you.

Last year at TransHealth, we attended a presentation at which a doctor who works with trans kids talked about hormone blockers becoming the standard of care, so that puberty can be held off for a few years and then the child, when older and more sure of herself, can go through puberty as her chosen gender. When we left the presentation, my partner--who does not talk about feelings much--cried on my shoulder. He is a man who was raised female and went through puberty as a female. The idea that things were changing, and the wish that such an option had been available to him as a young person, broke his heart a little.
posted by not that girl at 7:18 AM on May 24, 2013 [30 favorites]

I had a lot of gender dysphoria and discomfort issues when I was a kid, wore boy's clothes, did not identify with women, hated all my feminine bits and desperately wished I wasn't a guy and wouldn't hit puberty. I was suicidal beginning in elementary school. Then during puberty I hated every single change that went through my body. I thought about cutting into my boobs or asking for breast reduction and lip reduction surgery. I didn't really become comfortable with being a woman until well into high school. I wasn't transgender though, just desperately insecure and depressed and trying to find my way in a sea of Barbie dolls and pink and Cosmo.

I'm a hell of a lot happier now and definitely feel right as a woman, not a dude. So when I see these kinds of situations, I wonder what would have happened if my parents had been more aware and open to the issue of transsexualism and had investigated that route. Would I be extremely disgruntled now, having been put on hormone blockers prematurely? Or would somebody have stopped them along the route and identified that I had other preconceptions and psychological issues that were causing the dysphoria, rather than being a true-blue transsexual?

On the one hand, there is incalculable psychological torment delivered on transsexuals who go through puberty as their not-identified sex. The post-puberty transwoman I know who is struggling to find her way through a sea of hormones and surgery and not having the money for either is completely miserable.

On the other hand, I imagine not having some of the physical feminine traits I currently have because my puberty was delayed and deep down I immediately revolt against it. And while I'm not interested in giving birth, if I was the infertility would be agonizing. For someone who already grew up with feelings of ugliness and feeling unloveable, as an adult the feeling I lost my physical womanhood would've made my ongoing struggle with depression that much worse.

That's why I'm so conflicted about these stories, the earlier you do this, the better it is for the actual transperson, but the worse it is for the kid who's just messed up.


Not trying to make this a "But what about ME" argument, but pointing out from personal experience there exists a real subset of children with gender dysphoria who are not actually transgender and would be ultimately harmed by the use of hormone blockers and later hormone treatment
posted by Anonymous at 7:34 AM on May 24, 2013

You can think of pubescent-age hormone treatments as doing something irreversible to a child, but you can also think of them as preventing something irreversible from happening to a child. Kids go through phases, but an almost-teenage child who has been a girl outwardly in every possible way except anatomically for six solid years and inwardly for much longer? (People have been telling me for 49 years that my solitude-, dog- and music-loving phases will subside any minute now.)

Parents and doctors have since time immemorial been making any number of irreversible life-altering decisions on behalf of children (usually without even consulting the kid), and in most cases nobody bats an eye.
posted by FelliniBlank at 7:38 AM on May 24, 2013 [5 favorites]

Most doctors are reluctant to perform a tubal ligation on women under 30 because people so frequently change their minds. Fertility is an entirely abstract concept to a child. Hell, when I had a breast reduction at 22 (not trans-related) I was fine with the idea of never being able to breast feed in some hypothetical future. It's different when the decision to have a child or not, or breast feed or not, is happening in the here and now.

Lest people think I am talking out of my ass, by today's labels I would definitely be filed under "genderqueer," though that term is new and I am old so I feel weird using that word. And I hated being a girl as a child in a way that would be labeled "gender dysphoria" today and I still have plenty of it. Having had a child, I can say that if I'd been given the modern treatment for gender dysphoria, I'd be extremely unhappy today.
posted by gentian at 7:38 AM on May 24, 2013 [1 favorite]

That's why I'm so conflicted about these stories, the earlier you do this, the better it is for the actual transperson, but the worse it is for the kid who's just messed up.

My tot was compliant enough for me to watch the whole video, and I think that abstractions like this detract from real people. For Josie, this is absolutely the right thing. For another kid? Maybe, maybe not. Every trans* kid's situation is different and doctors absolutely err on the side of caution. I don't worry that needing to go to another *state* and see an expert over the course if several *years* to even get hormone blockers, which are reversible, is going to lead to a slippery slope of allowing gender dysphoria to mask kids who are "just messed up."

Truly, Josie is a lucky girl to have access to a loving, supportive family and good medical care. The lack of either/both of these is a far greater problem for trans* kids than the potential to start treatment and change their minds later.
posted by sonika at 7:42 AM on May 24, 2013 [9 favorites]

Not trying to make this a "But what about ME" argument, but pointing out from personal experience there exists a real subset of children with gender dysphoria who are not actually transgender and would be ultimately harmed by the use of hormone blockers and later hormone treatment

Excellent point. In the video, when the "would you love me if I were a boy, boy on the inside but a girl on the outside" conversation came up, I told my monitor, "Honey, you can be one or the other, or neither, or both, or anything that feels right and comfortable to you. You don't have to choose one thing -- or you can choose one thing and change your mind later."
posted by FelliniBlank at 7:43 AM on May 24, 2013 [3 favorites]

Most doctors are reluctant to perform a tubal ligation on women under 30 because people so frequently change their minds. Fertility is an entirely abstract concept to a child. Hell, when I had a breast reduction at 22 (not trans-related) I was fine with the idea of never being able to breast feed in some hypothetical future. It's different when the decision to have a child or not, or breast feed or not, is happening in the here and now.

I would argue from my limited experience, that tubal ligation or being able to breast feed would be things that you could change your mind about more easily, because they don't, you know, define who you are as a person. They are things you can do, not who you are.

You don't think of people as 'fertile woman' and 'unfertile woman', or 'people able to breastfeed' and 'people unable to breastfeed'.

But most people do think of others as 'man' or 'woman'.
posted by trogdole at 7:45 AM on May 24, 2013 [2 favorites]

Parents and doctors have since time immemorial been making any number of irreversible life-altering decisions on behalf of children (usually without even consulting the kid), and in most cases nobody bats an eye.

That's not true. Ever since children were started to be seen as children and individual people, not miniature adults or property of their parents, it has become less and less popular to make irreversible life-altering decisions, whether it's marrying them off or engaging in circumcision (male or female).

Kids go through phases, but an almost-teenage child who has been a girl outwardly in every possible way except anatomically for six solid years and inwardly for much longer?

The only reason I wasn't living as a boy past the age of 3 or 4 was because I wasn't aware it was even an option. My parents treated the whole thing as a phase, where they'd indulge the boy's clothing but didn't have seriously considered it could be a lifelong issue (and thank goodness they didn't). All I'm saying is while we look at the issue it is important to acknowledge the degree of harm blockers and treatments could visit on non-trans* children.
posted by Anonymous at 7:47 AM on May 24, 2013

The only reason I wasn't living as a boy past the age of 3 or 4 was because I wasn't aware it was even an option

But a lot of trans children KNOW they are trans. They insist on being called by the right pronouns, and insist on wearing the right clothes.
posted by roomthreeseventeen at 7:51 AM on May 24, 2013 [2 favorites]

ennui.bz: the hand that dispenses hormone-blocking pills, is the same one that surgically reassigns unacceptable genitalia. be careful what you wish for.

You seem to be suggesting that the doctors have an incentive to dispense more pills in the hopes of return gender-reassignment surgery.

#1. No, they aren't the same hands. Specialized surgeons don't write prescriptions for pills years in advance of surgery.

#2. Do you have the slightest shred of evidence that anyone has ever pushed gender reassignment surgery in pursuit of dollars, over the best interests of their patients? Seems like it would be a lot easier to just do boob jobs and lip implants.
posted by IAmBroom at 7:53 AM on May 24, 2013 [5 favorites]

OH MY. I just watched the video and if I could tell you how many times I got chills.

I work with the trans* community quite frequently. I think they would all be so heartened to hear the doctor say, "We make a commitment to do no harm. If doing nothing is harmful, then we have to do something."

Also, I was so thrilled to hear when the argument was posed that these kids are too young to make this decision that these kids are not too young to take their own lives. Which they do. Too often. In fact, 41% of transgender people have attempted suicide. This little girl considered self-surgery to remove her penis. Hormone blockers seem like a medical necessity.

I am so happy to be living in this time.
posted by Sophie1 at 7:59 AM on May 24, 2013 [15 favorites]

All I'm saying is while we look at the issue it is important to acknowledge the degree of harm blockers and treatments could visit on non-trans* children.

Given how hard it is for trans* kids to get access to medical treatment, I am in no way worried that a non trans* kid will get placed on gender changing hormones that will ruin their lives. This particular child needed to wait over a year before getting blockers and another two years to get estrogen after *living as a girl* for *years.* This is a very different thing from simply dressing as another gender.

So, no, I don't in any way think that better care for trans* kids has even a shred of potential to harm a non trans* child, even one who presents with some degree of gender dysphoria.
posted by sonika at 8:04 AM on May 24, 2013 [11 favorites]

This quote is actually from another one of today's FPPs:

Zasloff persisted [in attempting to get Kaplan to join him in his research], asking Kaplan to join him for some upcoming appointments he had with young FOP patients, including a baby named Tiffany Linker.

"That was it,¡± Kaplan told me. ¡°In an adult, you see what¡¯s already past. When you meet a child, it¡¯s like seeing a beautiful building, and a plane¡¯s about to destroy it.¡±

As a parent, if I saw a plane (impending puberty), headed toward my beautiful building (child), why wouldn't I do whatever I could to prevent it?
posted by Juliet Banana at 8:08 AM on May 24, 2013 [3 favorites]

I don't think that ennui.bz is suggesting that the surgical-reassignment folks are chasing dollars. Surgical reassignment of children with ambiguous genitalia was, perhaps is, standard practice even in places where doctors are salaried and administrators discourage unnecessary operations. Hormone treatments are more reversible than surgery, and children can express wishes in ways that newborns cannot, but in each case we're deferring to doctors' judgment about life-altering procedures.

Surgical reassignment of infants is a relatively-common procedure and the fact that it is so heavily deprecated by many of its survivors should remind us that we need to constantly challenge our assumptions about best medical practice. As ennui.bz pointed out, the same authority that lets doctors reassign ambiguous genitalia allows them to prescribe hormone blockers. It's a lot of power to place in individuals' hands and we need every new treatment to be included in an ongoing discussion about what is wise and appropriate.

That being said, I think this instance shows that someone needs to have this authority and I don't believe we have a better alternative than decisions reached by parents or caregivers in consultation with their children's doctors.
posted by Joe in Australia at 8:33 AM on May 24, 2013 [1 favorite]

By today's labels I would definitely be filed under "genderqueer," though that term is new and I am old so I feel weird using that word. And I hated being a girl as a child in a way that would be labeled "gender dysphoria" today and I still have plenty of it.Having had a child, I can say that if I'd been given the modern treatment for gender dysphoria, I'd be extremely unhappy today.

But the thing is, none of us can know that about any of the roads not taken in our lives. I mean, yeah, I can say, I love my existence and am happy with it. But I don't know that I would have been less happy or miserable if I'd become a monogamous heterosexual Republican soccer mom living in London or something.

As a not-strongly-gendered, inconsistently-sexual semi-non-oriented genderqueer androgynous weirdo myself, I think that those of us who are floating around the vast middle between the crazy ends of the binaries have it much easier than the people who identify strongly as a particular thing because we have the potential to become comfortable with whatever thing we happen to lean toward at any given moment, and I can be what I am pretty unobtrusively without concealing it. Although of course the world is quite happy to tell me all day long every single day that nearly everything I am is wrong sick twisted broken ridiculous puzzling and definitely unlovable, but hey, fuck 'em.
posted by FelliniBlank at 8:45 AM on May 24, 2013 [7 favorites]

As ennui.bz pointed out, the same authority that lets doctors reassign ambiguous genitalia allows them to prescribe hormone blockers. It's a lot of power to place in individuals' hands and we need every new treatment to be included in an ongoing discussion about what is wise and appropriate.

The important thing to remember (and Joe, to be clear, I don't think you're ignoring this), is that there is an ongoing discussion, but it's one the people wringing their hands the most in this thread are not privy to as they'd rather pontificate than try to learn something about the subject.
posted by hoyland at 8:53 AM on May 24, 2013 [4 favorites]

Man, I would LOVE to see exactly the thoughtful process of learning, discussing, and choosing that Josie, her parents, and her doctors are engaging in be the standard before any elective body-modifying treatment/procedure is performed on a child.
posted by FelliniBlank at 8:59 AM on May 24, 2013 [1 favorite]

On the other hand, I imagine not having some of the physical feminine traits I currently have because my puberty was delayed and deep down I immediately revolt against it.

Umm... what 'physical feminine traits' would you lose? The video is sloppy and in its fixation with fertility implies that hormone blockers interfere with future fertility, which is not the case (see question two of the FAQ).

Does it not occur to you that your parents possibly never considered it as anything more than a phase precisely because the situation didn't seem dire because you weren't trans? Sure, some of it's the time and place you grew up, but some of it is that the idea didn't need to occur to them.
posted by hoyland at 9:00 AM on May 24, 2013 [5 favorites]

Not trying to make this a "But what about ME" argument,

No, see, I think this is great, because all too often in discussions like this we get into arguments very specifically because sometimes people wander off deep into "But what about totally hypothetical edge-case...." territory. I think it's much more useful and thoughtful to actually get really personal (if one can) about it. It's even more helpful when people speaking from personal experience as well as those reading can remember that saying "In my experience blahblah" does not have to conclude in "...and therefore no other experience is valid, and everyone should do what I did."
posted by rtha at 9:07 AM on May 24, 2013 [10 favorites]

Someone who is not me posted a link to this useful article about the use of hormone blockers in another recent conversation here at MetaFilter (I think in MetaTalk maybe?). I bookmarked it becuase I found it helpful; it answered some of the questions I have as the parent of a child who seems likely to want this treatment when he is older.

The article says that hormone blockers should be started when the child is in Tanner stage II or III of puberty. I was not familiar with Tanner stages until quite recently, so here's an overview (pdf).
posted by not that girl at 9:16 AM on May 24, 2013 [3 favorites]

Does it not occur to you that your parents possibly never considered it as anything more than a phase precisely because the situation didn't seem dire because you weren't trans? Sure, some of it's the time and place you grew up, but some of it is that the idea didn't need to occur to them.

My parents considered how I acted as a phase as well though, and I am trans. So parent's reactions aren't exactly telling.
posted by trogdole at 9:53 AM on May 24, 2013 [2 favorites]

My parents considered how I acted as a phase as well though, and I am trans. So parent's reactions aren't exactly telling.

Of course, but the point is we shouldn't expect many parents to incorrectly identify their gender non-conforming child as trans. As you say, the reverse is drastically more likely to happen.
posted by hoyland at 10:10 AM on May 24, 2013 [3 favorites]

My parents considered how I acted as a phase as well though, and I am trans. So parent's reactions aren't exactly telling.

Of course, but the point is we shouldn't expect many parents to incorrectly identify their gender non-conforming child as trans. As you say, the reverse is drastically more likely to happen.

I wasn't seeing it that way, that's incredibly accurate. If the parents are agreeing with the child that they aren't their birth gender, the mutual agreement is probably a pretty good sign that they're correct.
posted by trogdole at 10:36 AM on May 24, 2013

While I don't believe that children are "too young" to make determinate choices about their gender, I have concerns about the cultural framework in which said choices are presented to children. By large, gender is presented as incredibly binary and rigid - a framework that even grown adults struggle with if these articles and subsequent discussions are any indication. Gender is one of those things that is notoriously difficult because can be seen from either a medical perspective, which attempts to sort gender into discrete categories based upon physical characteristics, or as a tremendously complex social construct with many hues and variations. Neither perspective is adequate to explain gender fully. While the medical perspective is clearly rooted and stagnant in our overall cultural framework of gender, it's also disingenuous to argue that gender does not have a physical, real-world role and impact. Thus, trans* people have to strike a balance between the two perspectives - and the issue is that not every person ends up with the same balance, and there is no one universal framework that works for everyone. I have friends who identify as genderqueer and give very little thought to their physical gender; but I also have friends who put tremendous weight on their physical presence. It's all about how they've individually come to their own value judgments about the social construct vs. the physical realities.

But despite the increasing pushback from evolving social views, there is no question that the medical aspect of gender still predominates and permeates through every aspect of our society - and children do pick on that. Combine that with a child's natural propensity to think of things in binary and very much rooted in the physical world, and I feel that puts tremendous pressure on a child to self-categorize as one or another without a full understanding of the tremendous social framework we try to view gender in - which is often contradictory towards medical perspectives.

I am so conflicted on this. If a child puts emphasis on their physical sexual characteristics as their personal definition of gender, how much of that is due to their own value judgments, and how much of that is due to their absorption of social attitudes and natural propensity to think in binary and physical notions due to their age?
posted by Conspire at 11:50 AM on May 24, 2013 [4 favorites]

If I recall correctly, the doctor said that about 80% of male-bodied children who identify as female or exhibit feminine behavior as young children actually choose to live as women post-puberty. The number is lower for female-bodied children who identify as male for some period of time; maybe about 50%? The theory is that it is so much more socially acceptable for girls to do things like wear boys' clothes and so on that a female-bodied child can be only moderately motivated and still be able to explore this aspect of herself, while the social cost is so much greater for male-bodied kids who want to act or dress like girls that that child has to really want it if they're going ot do it.

Could the different statuses of male and female also be a factor? As a kid, I would have said at times that I wished to be a boy, but that was because boys had cooler toys, more parts in plays, etc, and not because I felt that I really was in the wrong body. I've done some reading around n female cross-dressers in the 17th century, and while a few were motivated by gender identity or sexual orientation, many others were motivated by job opportunities or safety (e.g. when travelling).

But it also is likely, as you note, that it is much easier for girls and women to be gender non-conforming than it is for men - though that is also because of the relative statuses of male and female. To draw from the 17th century again, it was a lot easier for authorities to understand why women wanted to be masculine (to "better" themselves) than for them to understand men who wanted to be feminine, and I think we still have that, possibly even stronger than they did then (because so many things - like make-up, showy clothing, etc, have been redefined from being masculine or gender neutral to being feminine).
posted by jb at 12:34 PM on May 24, 2013 [4 favorites]

But it doesn't matter if children think in binary and feel pressured to self-categorize. That's precisely why hormone blockers are so important. It gives them time to evaluate and re-evaluate who they are and what they want to be. They're reversible. If a child decides that transitioning isn't right for them then they go off the hormone blockers and go through puberty. If they decide that they do want to transition then they get the appropriate hormones for that. Failing to give hormone blockers to a child who is about to go through the incorrect puberty is cruel and unecessary.
posted by elsietheeel at 12:37 PM on May 24, 2013 [5 favorites]

As a kid, I would have said at times that I wished to be a boy

This isn't what most trans kids do though. They KNOW they're the opposite gender. They KNOW that their bodies don't match who they really are. It's not just about toys and clothes and gender roles.
posted by elsietheeel at 12:39 PM on May 24, 2013

I am a transgender woman, I've know it since my earliest memories. My father tried to kill me three times trying to make me a man at 6-8 years old. My father deserted my mom and my two brothers when I was 9, but not before using me as a punching bag for everything he was angry about. Back then, 50's, I could not find any information on why or what I was feeling. To make matters worse I was sexually molested by a family friend and later gang raped at a wedding by 5 men. I learned to not tell anyone anything. It would only lead to pain. I built a wall of armor around me. Trying to be "a Man" I married a wonder girl at 21, we are still married after 41 years and trying very hard to make it work. But I will tell you that, I knew I was female as soon as I could tell the difference between boys and girls. I lived in a hell of my own making, trying to be something I wasn't and hating it, after feeling like a worthless piece of something less than humanity for over 40 years I entered therapy. I was a very bitter, angry alcoholic. After 5 years of therapy, I understood, I spent the next 3 years in therapy trying to convince myself I was not transgender. I failed. I have changed my name, I live as a woman, I still still feel extremely guilty for the pain I've put my beautiful wife and family through. My family has accepted me, I've accepted me and my God has accepted me. I would wish that no child ever be put through what I have gone through. For the first time in my life, I understand and embrace who I am.
posted by Finnaly Pam at 12:43 PM on May 24, 2013 [27 favorites]

This isn't what most trans kids do though. They KNOW they're the opposite gender. They KNOW that their bodies don't match who they really are. It's not just about toys and clothes and gender roles.

I know that - but I was just thinking through some of the reasons why fewer female-bodied children who are gender non-conforming or express desires to be male turn out to be transgendered or chose to transition.
posted by jb at 1:13 PM on May 24, 2013 [1 favorite]

Just to clarify: I totally support hormone blockers and delaying puberty for trans kids - precisely because it makes later transition so much easier.

I was just wondering off the top of my head about the sex/gender difference that not that girl mentioned - and maybe it's a derail, so please ignore.
posted by jb at 1:17 PM on May 24, 2013 [1 favorite]

Our views on what people should do in a particular hypothetical situation are often different from our views on what we ought to do in that same hypothetical situation. When we're talking about other people we incorporate two unknowns into the equation: we don't know whether we trust them to make any decision; and we don't know whether we would trust anyone (even ourselves) to make this decision. When we compound the factors it makes us conservative and judgmental about other people's decisions. In contrast, we generally do trust our own decision-making, or at least our judgment about whether we can make a good decisions; and we are consequently more liberal about our own judgment.

In this instance we aren't sure whether Josie's parents can make the right choice. And we don't know the full situation, so we're not even sure that we could make the right choice. When we compound those uncertainties it makes us very reluctant to approve their actions: if we had this degree of uncertainty we wouldn't even approve our own actions. But of course this is a fallacy: the uncertainty exists precisely because we aren't Josie's parents; if we were her parents we would have better information about Josie and about our decisions and we would probably trust ourselves to make the right decision.

As a consequence of this cognitive paradox I tend to worry about Josie's treatment: Are her parents sure? How can they be sure? What if they're wrong? Intellectually, however, I know that I'm assessing these risks incorrectly. As the people on the spot they have better information about Josie and their own decisions than I do, and their assessment is more likely to be correct than my own. In the absence of other information my confidence in their decision should be the same as my confidence in my own.
posted by Joe in Australia at 1:41 PM on May 24, 2013 [23 favorites]

Our views on what people should do in a particular hypothetical situation are often different from our views on what we ought to do in that same hypothetical situation. When we're talking about other people we incorporate two unknowns into the equation: we don't know whether we trust them to make any decision; and we don't know whether we would trust anyone (even ourselves) to make this decision. When we compound the factors it makes us conservative and judgmental about other people's decisions. In contrast, we generally do trust our own decision-making, or at least our judgment about whether we can make a good decisions; and we are consequently more liberal about our own judgment.

Thank you, thank you, thank you for this comment. You've done a lot to explain my first instinctive reflexes in reading these articles, and this is going to be tremendously helpful int eh future.
posted by Conspire at 1:47 PM on May 24, 2013

Does it not occur to you that your parents possibly never considered it as anything more than a phase precisely because the situation didn't seem dire because you weren't trans? Sure, some of it's the time and place you grew up, but some of it is that the idea didn't need to occur to them.

Or it was because my mom was desperate about her children being perfect and normal, and regarded my suicidal depression as an inconvenience I perpetuated in order to make her look bad, and thought my attraction to women was a phase as well (it's not!)? In a more trans-aware family I may well have been plugged into the "trans" box when really all I needed was an understanding of the gender continuum and my place on it.

There exist tremendously troubled children with gender dysmorphia who are not trans and should not be treated as such, and if not examined by tremendously informed and understanding experts could end up on hormone treatments they don't need. It is troubling that they're considered an afterthought in this thread, and that the effects of the hormone blockers are so minimized.
posted by Anonymous at 3:48 PM on May 24, 2013

Sounds like you're judging when you're telling us what you'd do with your hypothetical child.

I think it's really important that we remember that individual people make choices for themselves and their children, and because they would choose to treat their children or hypothetical children in a particular way does not mean they are judging everyone else who does differently. Parenting is incredibly hard and fraught with a lot of really important decisions that no one is ever sure they're doing right. More kindness, not less, in these circumstances, is warranted.

Transitioning is hard, but also time sensitive. Waiting until the age of majority means dealing with the indelible changes of puberty.

Like Joe in Australia, I can't help but think of the intersex / ambiguous genitalia issues, especially since there's an active thread on it. And it does seem strange that there seems to be little to no consistency on these issues. The argument is that intersex individuals with ambiguous genitalia should wait until after puberty to get their genital surgery, even though that means they will have to deal with the indelible changes of puberty. But that transgendered individuals should not have to wait until after puberty to get hormone blockers. There's some inconsistency there, and I wish I understood what was at the root of it.
posted by corb at 3:57 PM on May 24, 2013

and that the effects of the hormone blockers are so minimized.

Can I ask what effects specifically are being minimized? From what I've read, when the person stops taking the blockers, they go through puberty normally. The long-term use of cross-sex hormones may cause infertility, but those are not the same thing as hormone blockers.
posted by rtha at 4:03 PM on May 24, 2013 [3 favorites]

World Professional Association for Transgender Health Standards of Care are the current broadly accepted standard for medical treatment of people with gender dysphoria. Previously, the Harry Benjamin International Gender Dysphoria Association Standards of Care prevailed.
posted by thatdawnperson at 4:20 PM on May 24, 2013

There exist tremendously troubled children with gender dysmorphia who are not trans and should not be treated as such, and if not examined by tremendously informed and understanding experts could end up on hormone treatments they don't need. It is troubling that they're considered an afterthought in this thread, and that the effects of the hormone blockers are so minimized.

I'm sorry, this is offensive concern trolling. This attitude insults doctors, it insults the parents of transgender children and it results in dead kids.
posted by hoyland at 4:21 PM on May 24, 2013 [6 favorites]

thatdawnperson: "World Professional Association for Transgender Health Standards of Care are the current broadly accepted standard for medical treatment of people with gender dysphoria. Previously, the Harry Benjamin International Gender Dysphoria Association Standards of Care prevailed."

WPATH and HBIGDA are the same organisation. It was renamed. Your first link is to the current version. Your second link is two versions and fifteen years out of date.
posted by hoyland at 4:22 PM on May 24, 2013 [1 favorite]

And it does seem strange that there seems to be little to no consistency on these issues. The argument is that intersex individuals with ambiguous genitalia should wait until after puberty to get their genital surgery, even though that means they will have to deal with the indelible changes of puberty. But that transgendered individuals should not have to wait until after puberty to get hormone blockers. There's some inconsistency there, and I wish I understood what was at the root of it.

I'm not sure what's so inconsistent about the two situations, because both involve delaying a permanent and life-altering occurrence until the affected person is of a reasonable enough age to make choices for themselves. The situations are completely different - being intersex would have an impact on physical gender expression but not necessarily gender identity, and being transgendered involves gender identity being at odds with physical gender expression. But essentially, the strategies both revolve around harm reduction. In the former, you don't want to lock an intersex person into conforming into a physical gender that may be at odds with their gender identity. In the latter, you don't want to complicate a transgender person's ability to deal with a physical gender at odds with their gender identity by development of secondary sexual characteristics that are odds to their gender identity.

Also, I would like to point out that since gender identity and physical gender expression are distinct, being intersex and taking hormone blockers would not necessarily be mutually exclusive if the intersex person was going to undergo a puberty at odds with their gender identity.
posted by Conspire at 4:27 PM on May 24, 2013 [4 favorites]

I really feel like the attempt to declare the difference in responses between surgery on intersex infants and possibly transgendered minors fails really, really badly. The two situations are just so different that I can't see how treating them differently is an "inconsistency".

One is deciding not to operate on an infant unless there's some compelling medical reason to do so, in light of the numerous and serious risks of operating.

The other is granting a child well past infancy, one that's capable of expressing their own thoughts and desires, some ability to act on those desires. Is it free of risk? Of course not. But neither is inaction!

They're wildly different situations.

I think "leaving it up to the child, their parents, and their physicians" is kind of the only option.
posted by kavasa at 4:30 PM on May 24, 2013

In a more trans-aware family I may well have been plugged into the "trans" box when really all I needed was an understanding of the gender continuum and my place on it.

Okay, I've stopped shaking(!) long enough to elaborate. Trans people and their allies are not recruiting. What they/we want is precisely for people understand their place on the gender continuum, to use your phrase. Funnily enough, that involves listening to others about how they understand their gender and giving them space to explore and not forcing people to transition willy-nilly. I'm rather unclear on how you have fallen under the opposite impression.
posted by hoyland at 4:33 PM on May 24, 2013 [2 favorites]

I'm sorry, this is offensive concern trolling. This attitude insults doctors, it insults the parents of transgender children and it results in dead kids.

Yes, because recounting the painful gender issues I had growing up and relating them to the current discussion is the equivalent of endorsing transperson suicide. I apologize if you have found my childhood and the tremendous gender confusion I experienced "concern trolling". In the future, I will attempt to rewrite my personal history to better fit your beliefs of how others experience gender and how that experience changes as they mature.

Perhaps I should go back in time and yell at third-grade-me for attempting to saw at her wrists because she felt so dissociated from her body and depressed. The fact that I am happy to be a woman now but wasn't then isn't indicative that some children's experience of their own gender changes as they mature. No, in actuality bringing up the subject is totally incongruous with transperson rights and I probably laugh when I watch Boys Don't Cry.
posted by Anonymous at 7:01 PM on May 24, 2013

Could someone enlighten me as to why some of you write trans with an asterisk after it? trans*
posted by IndigoRain at 7:40 PM on May 24, 2013

Could someone enlighten me as to why some of you write trans with an asterisk after it? trans*

Because some people with various kinds of trans* identities self-identify using several different words beginning with "trans," and the * is shorthand for trans[fill in the word you find appropriate]. So people who identify as trans[gendered person], trans[man], trans[woman], trans[sexual], trans[kid], or trans[ylvanian] could all use the one abbreviation.

Doesn't the asterisk in abbreviations like that come from how you used to copy multiple files in DOS? You know, if you wanted to copy or delete every file beginning with MeFi, you'd do like COPY A:MeFi*.* C:
posted by FelliniBlank at 8:04 PM on May 24, 2013 [1 favorite]

The article says that hormone blockers should be started when the child is in Tanner stage II or III of puberty. I was not familiar with Tanner stages until quite recently, so here's an overview (pdf).
posted by not that girl at 11:16 AM on May 24

I would be willing to bet that somewhere in another 5 to 20 years the standard of care changes to stage I or the earliest sign of stage II. I'm not anybody's doctor. But listening to adult transgender people, it's not hard to hear how much pain and anxiety could be avoided by delaying any onset of sexual characteristics of the sex that they wished to avoid becoming. How much happier and more secure would young gender dysphoric children be if they were told that they would never be forced to acquire any physical traits of the gender that they don't want to become?

At present, I admit to being confused and conflicted about when is the best time to allow for permanent changes via either trans gender hormones and/or surgery. But blockers? From what I see via the links here, I think these should be used much, much more liberally.
posted by marsha56 at 8:41 PM on May 24, 2013 [1 favorite]

Yes, because recounting the painful gender issues I had growing up and relating them to the current discussion is the equivalent of endorsing transperson suicide.

No, but asserting that non-trans* kids are in danger of being harmed by hormone blockers if they are available to trans* kids - based solely on your experience - is most definitely problematic. Your experience of gender is valid, and so is the experience of trans* kids for whom hormone blockers are the right choice. The hypothetical kid who is going through your childhood struggles right now may or may not get blockers, but that is for specialists and parents to decide, not the MeFi Gender Police.

I can't reiterate enough how difficult it is for trans* kids to have access to proper medical care by people who take them seriously. The potential for a non-trans* kid with gender dysphoria to end up on non-irreversible hormones is vanishingly small, given how hard they would have to work to get them in the first place. Arguing the edge cases of this scenario feels like an attempt to negate the reality of how damn hard it is for a trans* kid to be taken seriously in the medical world at all.
posted by sonika at 9:54 PM on May 24, 2013 [6 favorites]

I think this topic is best served if people consider each transgender person a unique individual with a personal story unto themselves and consider each story on a case by case basis.
I believe that if we try to limit generalizations, broad insinuations and over-prescriptive pontification we can have a meaningful dialogue on this topic about the fears and concerns people may have in a way that limits accidental marginalization of people going through this.
Just my two cents.
posted by Annika Cicada at 10:31 PM on May 24, 2013 [2 favorites]

In the former, you don't want to lock an intersex person into conforming into a physical gender that may be at odds with their gender identity. In the latter, you don't want to complicate a transgender person's ability to deal with a physical gender at odds with their gender identity by development of secondary sexual characteristics that are odds to their gender identity.

Right, but wouldn't you be, by having intersex folk have to wait until after puberty to surgically correct their genital anomalies, complicating their ability to deal with a physical gender at odds with their gender identity by development of those same secondary sexual characteristics at odds to their gender identity?

The potential for a non-trans* kid with gender dysphoria to end up on non-irreversible hormones is vanishingly small, given how hard they would have to work to get them in the first place.

Well, but isn't the goal to make them not work so hard in future? I mean, surely folk don't think the way it is now is the ultimate ideal state, right?

People expressing concerns aren't necessarily, I think, talking only about today - they're musing philosophical, personal, moral and parental questions about this stuff. Schroedinger isn't talking about what her experience was - she's talking about what her experience might have been in a hypothetical situation in which parents were more concerned about these issues. Possibly it's a concern about the swinging of the pendulum - because people rarely take middle grounds on these issues, they swing from one to the other.

I understand that this isn't an academic or philosophical issue for transfolk, that it's a really emotional issue. But I think that little is served by attacking potential allies who also struggled with gender instead of addressing their concerns. Many of us struggled with gender growing up, particularly girls, who grow up in a world that is so hard for them. I remember growing up in the earlier days of the internet, I adopted a completely male persona for a while to try out my feelings of not wanting to be me, because life for girls is hard, and boys seem to get more freedoms and things.

And so there has to be some meeting of the minds between people who honestly and genuinely say, "I struggled with gender issues when I was a kid, but when I got older I realized that I was indeed the gender I was born with, and I worry that people are overprescribing hormones and hormone blockers for kids who might be like me" and people who say, "I can never look like a born-person version of my gender, because of the hormones that hit me in puberty and gave me all the secondary sex characteristics."

I think ultimately what that might look like is figuring out how to tell the difference between someone who is genuinely trans and someone who just has gender dysphoria - and that's going to be hard, because transfolk are rightfully suspicious of anything that seems like lessening of their hard-won acceptance. But I think it's still an important question. Because transfolk exist does not mean gender dysphoria doesn't.
posted by corb at 3:51 AM on May 25, 2013 [3 favorites]

But I think that little is served by attacking potential allies who also struggled with gender instead of addressing their concerns.

Well, this is what I am attempting to do. From a hypothetical "What if..." perspective, any number of things are possible. But. When dealing with the *reality* of a medical framework in which psychologists and other specialists are required for a diagnosis of GID beyond simple "gender dysphoria" the sort of hand wringing about hormone access is akin to "What if someone who just had high blood sugar once got prescribed insulin their entire lives."

In an ideal world, that trans* folk and allies are working towards, each individual will be able to make the determination with their doctor what is needed to present their gender in a way that feels right. For most of us, that's "nothing." For some trans*/genderqueer folk, that might mean not making physiological changes and modifying their presentation of gender rather than their hormones or having surgery. For others, it might mean hormone blockers. Etc. The point is that each person individually should be treated according to what is best for them over time. This isn't something that will, or should, ever be as easy as going to the doctor and walking out with a scrip for estrogen.

The problem with "what if..." is that you don't know. The reality is that for kids like Josie, she and her family and doctors *do* know that this is what she needs. When you keep playing "what if..." with hypotheticals in these situations, it pushes aside the reality of the situation into a thought experiment - which to me, doesn't feel like a productive conversation. Also, the conversation is focusing on the narrative of "that would have ruined my life" and pushing aside the narratives of others who say "I wish I'd had access to that" and while they're both valid, the former is shouting down the latter in the form of appealing to concern for edge cases.
posted by sonika at 5:29 AM on May 25, 2013 [6 favorites]

Yeah, I'm not sure how many actually watched the video that is the post link, but I definitely didn't see anything in there that would prompt the "I worry that people are overprescribing hormones and hormone blockers" line of argument; this doctor was being very cautious.

People who know more should correct me, but it's my understanding that body dysmorphic disorder that might be expressed as gender dysphoria is treatable with psychotherapy and (but not necessarily) pharmaceuticals such as SSIs, while GID/gender dysphoria is not, and so doctors spend a great deal of time either ruling out or treating possible contributing factors such as depression, OCD, etc. before even thinking about getting to the stage of prescribing blockers or hormones, for exactly this reason of distinguishing between the two.
posted by taz at 5:53 AM on May 25, 2013 [1 favorite]

I've got a question: the side effects mentioned above included possible infertility. Is that a possible side effect for hormone blockers, or only for actual hormone therapy?

What are the side effects for hormone blockers? Because if there aren't any serious side effects, I can't see the downside, even for people who eventually chose not to transition. It's just putting off a decision. I've heard that it will make female-born people a bit taller, but most cis women wouldn't complain about that, let alone women who are more genderqueer.

As well, hormone blockers have other applications - some children come into puberty way, way too early (like 5 or 6 years old), and it might be better for them (physically as well as psychologically) to delay that puberty. (Hormone therapy has also been used with a severely disabled child to instigate early puberty to limit their growth - that was pretty controversial, too, but I thought the parents made a really good choice).
posted by jb at 6:06 AM on May 25, 2013

Hormone blockers do not cause infertility. They have indeed been used for kids who have entered into puberty too early - I believe that is the original use of the drugs, they've since been used for trans* kids as an expansion of that. I don't know about long term consequences, but the drug is reversible - you stop taking it, your hormones go back to normal.
posted by sonika at 6:23 AM on May 25, 2013

doctors spend a great deal of time either ruling out or treating possible contributing factors such as depression, OCD, etc. before even thinking about getting to the stage of prescribing blockers or hormones, for exactly this reason of distinguishing between the two.

Also, the experience of trans* friends of mine has been exactly this. It is very frustrating at times, but they have definitely had to have other factors ruled out by both a therapist and a specialist (usually an endocrinologist) before receiving hormones. It's a huge step and often they have to spend [x] amount of time living as [gender] first, which definitely poses a huge barrier that prevents them from being prescribed frivolously. A lot of trans* folk would argue the current standards of care are too strict, but it's how things are for now.
posted by sonika at 6:30 AM on May 25, 2013

It's a huge step and often they have to spend [x] amount of time living as [gender] first, which definitely poses a huge barrier that prevents them from being prescribed frivolously.

At the risk of giving people just enough knowledge to be dangerous, the so-called Real Life Experience is actually gone from the Standards of Care because it simply wasn't feasible for many people. (I actually went back and checked the fifth version, which someone linked to above. Seemingly RLE was technically not obligatory even then, but I'm sure that will be met by a chorus of 'as if'.) There are two things to be noted here. One is that the Standards of Care are not something that is enforced. The other is that, despite the Standards of Care being seen in some circles as unnecessarily onerous or biased towards a certain narrative of experience (and against other experiences), there are plenty of doctors imposing far more onerous protocols on their patients. (I believe to access hormones on the NHS, you need to have been 'living in role' much longer than three months, for example.) Or one's doctor may be perfectly happy to prescribe hormones, but the insurance company wrote their rules 20 years ago and has no idea what current practice is, so imposes their own requirements. In other words, there's no reason to doubt what sonika says about her friends' experiences. Many people also transition socially before pursuing hormones, either by choice or because there are other barriers to accessing hormone therapy.

I've got a question: the side effects mentioned above included possible infertility. Is that a possible side effect for hormone blockers, or only for actual hormone therapy?

Somewhere above, I linked to a FAQ at UCSF that addresses this, but, like sonika said, the answer's that hormone blockers don't impact fertility.

I actually think the video's obsession with fertility is kind of weird. It's not as if hormone therapy in the course of transitioning is the unique thing that can lead to a loss of fertility earlier than you'd otherwise expect, but it's perhaps one of few NBC can call 'controversial'. Does it make sense to talk about infertility as a 'side effect' of hormone therapy given that it's what you'd expect cross-sex hormones to do? (If one stops taking hormones, one may or may not recover fertility for reasons that aren't, as far as I know, well understood. People are told to assume they won't.)

Anyway, I will do my best to confine my participation in this thread to providing information, at least for now.
posted by hoyland at 7:51 AM on May 25, 2013 [3 favorites]

Right, but wouldn't you be, by having intersex folk have to wait until after puberty to surgically correct their genital anomalies, complicating their ability to deal with a physical gender at odds with their gender identity by development of those same secondary sexual characteristics at odds to their gender identity?

I don't know that there's any medical requirement that says wait until after puberty. The standard now seems to be as soon as possible after birth, which is awful.

There may be various physical or hormonal reasons why it might be better to wait until after puberty, but really what is most desired is to wait until the child is old enough to express their desires and opinions, which certainly happens before puberty. Intersex kids are not automatically trans* and do not automatically have gender dysphoria.
posted by rtha at 8:50 AM on May 25, 2013 [3 favorites]

And now that I've had a little coffee, I'm realizing that of course we likely don't have enough data or even anecdata to know whether or not intersex kids may or may not be trans* because most babies born with ambiguous genitalia get surgery long before they can express anything about how they feel about their bodies. Which is barbaric.
posted by rtha at 9:27 AM on May 25, 2013 [5 favorites]

For what it's worth, I was considering writing a concern comment before I realized that it was just delaying puberty and then I RTFA and some comments and didn't comment off the cuff afterall. For people who don't want to watch a Single Link Youtube, Dateline has a write-up here: http://insidedateline.nbcnews.com/_news/2012/07/08/12625007-transgender-children-in-america-encounter-new-crossroads-with-medicine?lite. I hope this works out awesome for Josie and it would be interesting to see some journal articles about how the outcomes tend to work out in similar cases. It looks like there are a lot of articles discussing the ethics involved here: http://scholar.google.com/scholar?q=transgender+children+puberty&btnG=&hl=en&as_sdt=0%2C9

I think the moment that I lost all respect for Dr. Drew was when I heard him on Loveline shaming and blathering hate at a parent who decided to prevent their infant with genital ambiguity from undergoing irreversible surgery at birth so that the child could make up their own mind when the time was right. "Blah blah, locker room, confusion, which bathroom, blah blah, kids bully, blah blah, save them from prejudice, blah blah." He was actually raging at this parent. Like, spare a thought for the fact that all of that confusion would be ameliorated and maybe even prevented if it wasn't for small minds like you?

From a cisgendered background, puberty was definitely the time when it seems like many of us have the realization, "OH, that's what those bits and pieces are for... Who knew?!" That may be part of the confusion going on here: assuming that that experience is universal when maybe it's not?

It's interesting to think that many youth have deep thoughts about their identity very early, but I would not doubt it when that's what they say is their experience. We can never enter the cave of another person's mind, at any age, so we have to take their identity declarations at face value. Kids can figure out a lot of things when they're not sheltered from thinking deeply about their world and their place in it. It seems wise to tend to stick to the most reversible course for as long as possible in any event but that seems to be what's going on here.
posted by Skwirl at 9:57 AM on May 25, 2013

Well, hey, might as well: I am also one of those people who thought I might be trans* when I was younger - after a lot of feelings of very strong rejection of the changes that happened to me during puberty - and came out of it, after a long period of exploration in which I experimented with presenting masculine and living as male in some very limited arenas, deciding I'm not.

But see, kids know this too. I knew I wasn't ready to try to fully transition to male. I knew I wanted to wait. I knew finding certainty was my own journey. I don't think I would have ever let anyone tell me otherwise - I think I would have rejected being pushed towards a more definitive masculinity the same way I rejected definitive femininity at the time. In fact, when people in my communities did identify me as trans* I would usually correct or hedge; I never felt comfortable identifying with the label even when people openly granted it to me. And now I'm happily living as a feminine-presenting-but-not-entirely-gender-conforming female individual.

I also think it's really important to caution against saying that "well, I knew I was a boy/girl deep down inside since I was born basically" is the one and only narrative of being trans*. Maybe not so relevant to this thread in particular, but there are many and varied journeys to figuring out who we really are.

(And yes, the asterisk is a wildcard character!)
posted by capricorn at 10:09 AM on May 25, 2013 [7 favorites]

When you keep playing "what if..." with hypotheticals in these situations, it pushes aside the reality of the situation into a thought experiment - which to me, doesn't feel like a productive conversation.

I think something that it's really important to restate here is that even though I know for many people this is their daily reality, for those of us for whom it is not a daily reality, we still need to process our thoughts and come to decisions on what we feel about things. And for some of us, myself included, we come to those places by asking thought questions and hypotheticals until we have them answered by other people and realize what we actually feel, given the situations.

I understand how frustrating that is - but I think that allowing us that process does get us to better outcomes for everyone.

For example, if you asked me a few days ago, I would have categorically insisted that if I had an intersex child, I would have done surgery at birth, as soon as possible, so as not to ruin the kid's life. I know this isn't exactly popular to say here, but this is what, if you asked me, I would have said that I would have done - and possibly what I actually would have done if it had come up.

Then we had the intersex thread, and I posed some hypotheticals there about questions and concerns that came up in my head, and guess what - I actually changed my mind based on the process of those. If I have an intersex child, I now plan on getting medical opinions on what gender the child likely is or is most like, raising them as that gender, but not getting the surgery done until the child is old enough to tell me if they're making a mistake. And again, I was able to come to that decision, which I think is a better decision, based on my hypotheticals being addressed.

The issue of transkids is another one that I haven't quite settled in my mind yet. I don't know what I'll do, especially around hormones and hormone blockers - but I know that teasing out these hypotheticals is how my thoughts process and come to a more firm understanding. So allowing those of us to pose hypotheticals is in fact productive, because it eventually alters reality - because if I do have a transkid, how I treat that situation is going to be contingent on which answers I've gotten to my hypotheticals along the way.
posted by corb at 10:38 AM on May 25, 2013 [8 favorites]

The argument is that intersex individuals with ambiguous genitalia should wait until after puberty to get their genital surgery, even though that means they will have to deal with the indelible changes of puberty. But that transgendered individuals should not have to wait until after puberty to get hormone blockers. There's some inconsistency there

Not really, as these are very different circumstances. For one thing, you're talking about undergoing surgery in one instance, taking hormones in another. Surgery is effectively permanent, while hormone therapy can be reversed.

Furthermore, intersex "corrective" surgery often takes place at a very young age, before the child in question can actively even communicate what they feel their gender is; hard to indicate this if you can't talk. So it's better to wait until they can indicate whether they feel they're a boy or a girl, neither or both, or something else entirely. And even then it may actually be safer or better not to do anything.

With trans kids taking hormone blockers on the other hand, you do have people who have not only said that they're really a boy or a girl, but have actively lived as their prefered gender, like Josie in the video.

Which brings us to the issue of consent: as far as trans kids can (legally) consent, they've consented to hormone blocker treatment while those intersex babies undergoing "corrective" surgery haven't.

Finally, surgery has very real health risks both in the operation itself as in longer term; you can be corrected to the right gender and still have loss of genital functionality. First do no harm very much applies here. In the case of hormone blockers the harm prevented by not having a child go through the wrong puberty is much greater than letting nature take its course.
posted by MartinWisse at 12:16 PM on May 25, 2013 [4 favorites]

The issue of transkids is another one that I haven't quite settled in my mind yet. I don't know what I'll do, especially around hormones and hormone blockers - but I know that teasing out these hypotheticals is how my thoughts process and come to a more firm understanding. So allowing those of us to pose hypotheticals is in fact productive, because it eventually alters reality - because if I do have a transkid, how I treat that situation is going to be contingent on which answers I've gotten to my hypotheticals along the way.

To be honest, I suspect the actual reality of having a trans child will quickly overwhelm any hypotheticals quickly though. There's only so much you can understand this way.

I'd be careful with hypotheticals as for many trans people the discussion here will be very familiar, as it's about the usual issue of how do you know for sure somebody is really trans and how can you prevent people from possibly making a mistake. Not to say that these things don't happen, but currently it's far more likely for a trans person to not get the help they need, or get it too late. Discussion about trans issues therefore often revolves around the wrong problems and doesn't really progress from there.
posted by MartinWisse at 12:37 PM on May 25, 2013 [6 favorites]

I'd be careful with hypotheticals as for many trans people the discussion here will be very familiar, as it's about the usual issue of how do you know for sure somebody is really trans and how can you prevent people from possibly making a mistake.

Agreed. While going over hypotheticals in your mind may be helpful for you, in a larger conversation the "What about..." s and "What if..." s *at best* lead to Trans 101, which is an exhausting conversation each and every time it comes up. At worst, it gives the appearance (even if not your intent) of trans* folk needing to prove their experiences as credible.

Asking questions isn't wrong, but engaging in endless hypotheticals can be exhausting for those who have lived through it. There's a middle ground of asking for infirmation/specifics and then running the hypothetical algorithm out for yourself.
posted by sonika at 2:13 PM on May 25, 2013 [7 favorites]

I think the hypotheticals serve well to get to a place where you can accept trans as a thing that exists, beyond that the only hypothetical is that each transperson's experience will be unique. Any preconceived models will probably fall apart rather quickly, so I'm hesitant to say you can have a reliable treatment plan for a trans* experience in the "just in case I need this someday" box.

The best thing you can have is a very open mind.
posted by Annika Cicada at 4:11 PM on May 25, 2013 [1 favorite]

I'm with Corb: the intersex thread was very enlightening and changed my assumptions about treatment.

I understand that people don't necessarily want to get into Trans 101 here (just as people don't want to get into Feminism 101 or Holocaust 101 or all the other subjects that seem to raise newbie questions) but without outsiders' input there's not much to say in a lot of these threads other than Hurray! or Boo!, depending. I really appreciate the patience people have had with my own dumbass questions in many threads, and in consequence I try to do the same on matters that touch me personally.
posted by Joe in Australia at 8:07 PM on May 25, 2013 [1 favorite]

but without outsiders' input there's not much to say in a lot of these threads other than Hurray! or Boo!, depending.

I think this is sort of the crux of the problem. But that's perhaps the tension of what makes a good post. (Yeah, this should really go in MeTa, though I kind of hope we can be allowed to have this conversation here because I don't think it would actually be had in MeTa.) If the standard is 'Here's something I found on the internet that I think other people might be interested in seeing and might not otherwise run across', I think this post clears that bar by a good margin. I'm not really a fan of the video, but I'm not really the target audience either. There's not much to discuss, though I can see it raising questions for some people. And that's totally okay. I think what's very much not okay with me is those questions overtly coming from the assumption that a) trans kids (or adults, as applicable) must be confused about their gender, b) doctors are cavalierly prescribing hormone blockers and hormones (that's the giveaway of not having paid any attention whatsoever) or c) trans people reinforce gender stereotypes and roles. To make things worse, trans posts seem to have been coming in pairs or triples and certainly my patience runs out.

I guess I want people to recognise the difference between "But most gender non-confirming kids aren't trans!" (strictly true, but not what we're talking about) and "I didn't really understand from the video how you distinguish a kid who's generally gender non-conforming from a kid who'd be well-served by transitioning young." (The video doesn't actually address this much at all, but whatever. Maybe the doctor says something about persistence, I don't remember.) My response to the former is "Are you kidding me?" but I would assume the second is in good faith.
posted by hoyland at 7:05 AM on May 26, 2013 [3 favorites]

To make things worse, trans posts seem to have been coming in pairs or triples and certainly my patience runs out.

I think that may actually be part of the problem, weirdly - not that all this stuff is happening around trans issues, but that each of them is getting their own post, which means the discussion, instead of all being concentrated in one thread and actually /getting/ anywhere, keeps jumping to each new post. Whereas with some subjects (most notably, guns comes to mind, but that may just be because I'm really involved and follow it) people are posting even new cool links and stuff in the same thread - which means there's less repeating yourself, because people can just scroll to stuff that has already been said. And in some ways, I think it'd be more useful to have all these links and stories clustered, because that in and of itself would also give some useful information - here are all these things, you can look at all these things and extrapolate blah.

There's not much to discuss, though I can see it raising questions for some people. And that's totally okay.

And I think this is also where having one thread with all this stuff dropped in would be better - people who are interested in these issues can still see it, but without that single link having to bear all the burden of the conversation. And so when you have things that you really can't say much about, because the link itself doesn't have a lot to discuss, you wind up coming up with these secondary conversations, about what-does-it-mean and how-do-you-tell and what-is-the-difference-between-hormones-and-blockers (which you know what, I feel like I may have been told multiple times and it is honestly still hard for me to remember because it's super complex.) Whereas if there's a bunch of links, there's more meat to discuss about the actual situations.
posted by corb at 7:49 AM on May 26, 2013

Whereas with some subjects (most notably, guns comes to mind, but that may just be because I'm really involved and follow it) people are posting even new cool links and stuff in the same thread - which means there's less repeating yourself, because people can just scroll to stuff that has already been said.

I really wish that were the case more often, but the Coy Mathis fpp and the meTa it spawned (and every feminism thread ever it feels like) belie that. Even early on in threads like those, there are always, always people who come in and either say upfront "I haven't read all the comments but [thing that has been addressed several times upthread]" or they just ask the question or say the thing that has been addressed several times upthread, making it clear that they haven't bothered to read the thread. It's part of the nature of online discussions and human nature, I suppose, and I don't know that there's an easy way around it.
posted by rtha at 10:41 AM on May 26, 2013 [3 favorites]

With the disclaimer that I'm someone who has never made a post on trans issues (and, to be honest, probably never will) and who hates when quasi-related links get dropped into the comments to a post, I'm reluctant to say we should encourage combining trans posts because, for example, this post and the Trans*scribe post last week are really pretty different and are probably of interest to different groups of people who aren't necessarily going to end up in every trans-related post. And then there was the intersex post too, which really, truly shouldn't be mixed with either of these two other posts, even though the intersex post came up here.

I suppose, inasmuch as I have the power to ask anything of people making these posts (which I don't), I would prefer that people think about (or check) whether their post is coming close on the heels of a related post and, if so, if it's a time-sensitive sort of post. So, for example, the Coy Mathis post was kind of a news post. Then in the middle of that blowing up, there was the post about the American Samoan footballer and I remember thinking "Why, oh why didn't you sit on this for a week or two?" That post was definitely about something distinct from bathroom access or trans kids and actually wasn't necessarily doomed to go in the direction it did, I don't think, but the timing sealed its fate.

On preview, though, rtha raises a very good point in the other direction.
posted by hoyland at 11:10 AM on May 26, 2013 [1 favorite]

Joe in Australia wrote: "... many parents are called upon to make serious medical decisions on behalf of their children, and we generally defer to their judgment. Why is this case different, and what other mechanism would you impose?"

Australian law would consider this case a "special medical procedure", sufficiently different to disallow (even) parental consent without prior approval from the Family Court. It's quite an imposition, especially where supportive parents find the legal costs preclusive. Authorisation from the Family Law Court of Australia is compulsory before any hormone treatment (stage 1 - puberty suppression, or stage 2 - desired hormone) may be commenced with a view to gender reassignment.

No reassignment surgery is legal prior to age 18, after which Family Court/parental consent becomes a non-issue.

Australia has only one clinic for gender identity dysphoria in children/adolescents running out of the Royal Children's Hospital, in Melbourne, since 2003, and through their parents, 9 trans-kids have won Family Court approval to go-ahead with treatment. The last two cases appear to be testing the "special medical procedure". There's an interesting decision pending.

Re Jamie [2012] 46 Fam LR 439 (pdf)
RE Jodie [2013] FamCA 62 (pdf)

Meanwhile Australia remains unique in its requirement for legal permission.
posted by de at 1:12 PM on May 26, 2013 [1 favorite]

I think that may actually be part of the problem, weirdly - not that all this stuff is happening around trans issues, but that each of them is getting their own post, which means the discussion, instead of all being concentrated in one thread and actually /getting/ anywhere, keeps jumping to each new post.

Yeah, I get your point, but on the other hand, it's not like you can smoosh all trans posts together either. I've noticed myself that there's more attention to trans issues on MeFi in the year and a half I've been active here and I think it's a good thing we're getting more diverse posts about this.

To be honest, the current post was always going to be trans 101 as after all it features a Dateline video; the trans scribe post on the other hand was much more about how various trans people lived their lives. It's nice to have both these posts up and neither of them getting too much bogged down in drama.

And if you doubt whether all of this does any good, there's corb's comment about how she changed her mind about intersex children; no mean feat.

Also, there do seem to be more out trans and genderqueer people posting here, which in itself probably means we're going to see more posts on these subjects, and why not?
posted by MartinWisse at 2:34 PM on May 26, 2013 [1 favorite]

As I think about this more, I wonder if zarq's efforts towards writing a wiki page is really the way to go. When he proposed it, I kind of doubted people needing a trans 101 would know to look for it, never mind read it. After all, I couldn't tell you the last time I looked at anything on the wiki. (Well, it was probably when he roughed out the page during that MeTa, but other than that I have no idea.) But, in theory, if such a page existed, one could have said in this post "Yeah, the video wasn't very clear about some stuff. Here's this wiki page that maybe makes some things clearer." and maybe be able to de-escalate a little because the burden of having to write it out yet again is gone. (On the other hand, shouldn't people be called on their crap? Maybe my little example sentence above is enough to get people to check themselves, even though it's not direct. I don't know.)

What's meant to go on this page, I don't know. Maybe write it as an FAQ and summarise the Standards of Care a little. (It has dawned on me that the way to avoid privileging the SOC so much is to talk about it as 'an example of a protocol'.) Cover corb's hormones v hormone blockers question. (Am I right that the confusing part is that anti-androgens (that one often takes together with estrogen) are intuitively 'hormone blockers', but not what we mean when we say 'hormone blockers'? Or was it the 'hormone treatment' in the post title that was confusing? Because that was confusing and, I think, NBC's fault.)

If this is actually something that happens, I suspect there is some sort of line to be drawn when it comes to how much detail to go into because, when it comes down to it, if we say 'hormone therapy turns you purple', that's something that's liable to be assumed of anyone who's out as trans (regardless of whether they say they're on hormones, probably) and it maybe isn't fair to them to have it right there on the wiki, even if the SOC goes into detail.
posted by hoyland at 8:30 PM on May 26, 2013

Cover corb's hormones v hormone blockers question. (Am I right that the confusing part is that anti-androgens (that one often takes together with estrogen) are intuitively 'hormone blockers', but not what we mean when we say 'hormone blockers'? Or was it the 'hormone treatment' in the post title that was confusing? Because that was confusing and, I think, NBC's fault.

Mostly right, yeah, the other part was slightly confusing as well. Honestly if this stuff - particularly around the differences in the hormones - was put in the wiki, I would personally appreciate it, because I think sometimes things are assumed to be ill intent when this is just stuff that is hard to remember. I mean, I myself have TBI, so things are harder to remember than usual and take more repetition to sink in, but I think even for other people, this stuff is not necessarily "hear once and learn completely." There also, like said above, is a huge difference emotionally in a thread between saying, "You're wrong, here's how completely you're wrong and I am going to paste it all here" and saying, "Hey, there's a wiki on this accessible here that explains some of the more confusing aspects."
posted by corb at 5:54 AM on May 27, 2013 [1 favorite]

If you've been told once, and you know you've been told once, I don't think it's unreasonable to do some of your own research before asking to be told again, especially with stuff like this:

I think something that it's really important to restate here is that even though I know for many people this is their daily reality, for those of us for whom it is not a daily reality, we still need to process our thoughts and come to decisions on what we feel about things. And for some of us, myself included, we come to those places by asking thought questions and hypotheticals until we have them answered by other people and realize what we actually feel, given the situations.

I understand how frustrating that is - but I think that allowing us that process does get us to better outcomes for everyone.

What it feels like is an attempt to maintain a status quo until all hypothetical concerns cis people have (inevitably about some tiny potential harm to cis people) can be met, which of course is impossible. The thread already reeks of cis privelege without the need to specifically ask trans people and their allies to be ever more patient with cis people, or accuse them of "inconsistency" nonsensically. The entire medical establishment in this area is set up to protect cis people first and help trans people second, and additional handwringing over trans people getting any kind of benefit of the doubt and access to basic care options is tremendously silly.

Maybe you're right that people might be more inclined to read a Mefi wiki entry than a Wikipedia entry, but Wikipedia and all of the links that have been dropped in threads over and over are still there to be read if you feel you need to go over things again before you feel informed enough to participate.
posted by Corinth at 2:17 PM on May 27, 2013 [5 favorites]

If you've been told once, and you know you've been told once, I don't think it's unreasonable to do some of your own research before asking to be told again

I don't know if you're deliberately arguing in bad faith or not, but please read the entry above just in case. For those of us for which it is not our daily lives, it is extremely difficult to recall details and specifics, even if we have been told, and even if, once told, we have hazy details of having been told before.

The subject I am most familiar with, where most MeFites are not, is firearms. I know I have gone into firearms thread after firearms thread and reminded often the same MeFites about the differences between automatic weapons and semiautomatic weapons, between cosmetic features and noncosmetic features, about all sorts of firing functionality. They frequently do not recall these details, nor do I expect them to. They rarely do their own research before participating, or if they do, they do so from sites that do not go into detail about technicalities. I find this frustrating and tiresome on occasion, but I do it time after time because I know I cannot expect other people to have as good a memory as myself on things they are not personally involved with. I've also patiently explained time and time again how people might feel personally connected to these situations and why they might be upset by other people's careless language.

It's not that hard, and I don't think it's that unreasonable to be willing to engage in that dialogue if I want people to be more informed about the subject.
posted by corb at 8:16 PM on May 27, 2013 [1 favorite]

corb's TL/DR:

"Do we really have to cover 'Feminism 101' again?"
"Yes, if you want your audience to understand what you are saying."

(replace with Racism/LGBT rights/Problems Parents of Special Needs Children Face/, as needed)
posted by IAmBroom at 12:55 AM on May 28, 2013 [3 favorites]

Oh, for Pete's sake. This is not elementary school. You're all grown adults with an internet connection. The difference between talking out of your ass about trans* people and talking out of your ass about guns is that when you're talking about guns, you're not actively perpetuating a status quo that treats the marginalized like second-class citizens with cis people and cis rights above all. It is not just fucking hurt feelings.

Honestly, when people talk about cis privilege, this is exactly what they mean. You're turning a trans* orientated discussion into one revolving around cis people, around how trans* policies harm cis people, around the right of cis people to expect to be constantly educated by trans* people on a repeated wherever they go assuming they even listen to them in the first place, around the hurt feelings of cis people, all because "you have a bad memory and can't be expected to remember every detail and/or spend twelve seconds googling it."

You aren't doing it on purpose, but do you seriously not see how this is an expression of cis privilege? Ignorance or lack of intent does not excuse the harm rising from your actions.

This is exactly what they mean when people tell you to "watch your privilege."
posted by Conspire at 10:23 AM on May 28, 2013

You aren't doing it on purpose, but do you seriously not see how this is an expression of cis privilege? Ignorance or lack of intent does not excuse the harm rising from your actions.

Everyone has privilege. Even you.

You're making fun of my statement of poor memory, even though I posted above that for me, personally, it is due to a disability. You are thus engaging in able-bodied privilege against the disabled.

The difference between us is that I don't think you're a bad person for that and should somehow stop speaking about your feelings, thoughts, and ideas.
posted by corb at 10:46 AM on May 28, 2013 [1 favorite]

Yes, thank you for helpfully pointing out my privilege. I appreciate it, because privilege is not a dirty word, and pointing out privilege is never intended as a value judgment. I apologize if you have interpreted my wording of your privilege as a value judgment; but I hope you will come to understand that when I, or for that matter, anyone else, points out that you're acting in an immensely privileged way, we are not calling you a bad person. We're merely trying to point out how your background may cause you to unknowingly act in oppressive ways, so you can work to further your personal stake in helping make the world a better place should you choose to.

What I feel you're mistaken on however is that you believe, knowingly or not, that your own status as a person in a marginalized group trumps another marginalized person's rights. Pointing that out is not able-bodied privilege (by the way, you're assuming that I am able-bodied - I have multiple severe mental and physical disabilities, several of which handicap my ability to emphasize and cognitively process information.) I understand that your disability causes memory issues; however, that does not give you a free pass to turn a discussion on trans* people into one on cis people.

I'm not asking you to censor your thoughts, feelings or ideas, nor am I saying that your thoughts, feelings and ideas are invalid or wrong in any way. What I'm saying is that you need to be more aware that your expression of your thoughts, feelings and ideas may have oppressive effects. Asking questions is a fantastic thing, and no one honestly minds it that you may have to do it a few times for these complex things to sink in, but you need to be very careful that you're not suddenly repurposing a trans space into a cis space when doing so. In some conversations, you may not have as much of a stake - rightfully - and there's better ways to approach these conversations than to try to forcibly carve out your own stake by asserting a right to information. You can educate yourself with the tremendous information out there and rightfully claim a voice, or you can stay quiet and save your thoughts for another space and day.

I'm saying this as one disabled person to another. I have a medical diagnosis of autism, and thus I've often struggled with the intricacies of social mannerisms in the past, so I am noting my observations to you; similarly, as someone with severe ADHD, I have memory issues as well, and I have found it more useful to keep online resources on hand to consult so when I'm frightened about how I can't really participate in a conversation like this due to my lack of knowledge, I can consult those resources instead of forcibly taking charge of the conversation by demanding that it focus on me and my own ignorance.
posted by Conspire at 11:16 AM on May 28, 2013 [1 favorite]

De's link to the Australian Family Court case Re Jamie [PDF] is brilliant. It's probably a good place for an outsider to start, because the judgement is lucid and delivered in the "as you know, Bob" judicial style that doesn't rely on any prior knowledge on the part of the reader. All the things I wondered about are addressed.

I wasn't actually aware that "special medical procedures" on children in Australia had to be approved by a judge. I can see that the delay of seeking judicial approval is a problem, but I'm rather glad that in this case it led to such a clear statement of the issues and concerns surrounding treatment.
posted by Joe in Australia at 12:04 PM on May 28, 2013

At some point, it must become one's own responsibility to keep track of the things that one knows one is bad at remembering. I have various notes and bookmarks; other methods may work better for others.

This is a really stupid example, but it's the first one that leapt to mind (and it's way less fraught than issues addressed in this thread): I can never remember which field marks go with the Eurasian wigeon (rare but reliable visitor to my part of Northern California) and which go with the American wigeon. I know they're different, and I know what the differences are, but my brain refuses to hang onto which differences go with which bird. I don't text my Best at Duck ID birding friends about it; I look it up in my field guide or on google.

Don't get me started on warblers. Or gulls. Or flycatchers. Talk about hard to remember!
posted by rtha at 12:04 PM on May 28, 2013 [1 favorite]

What I'm saying is that you need to be more aware that your expression of your thoughts, feelings and ideas may have oppressive effects.

I am aware of this, but I think it's important to limit this to specific oppressive effects. If you notice a way in which my actions feel oppressive to you, please do say something, but I think we are all best served when that is more like "You did X, and that contributed to Y bad thing" rather than with mocking tones and comparisons to children. Aside from the "hurt feelings" that seem to bother you so much, it also just seems astonishingly unproductive.

Asking questions is a fantastic thing, and no one honestly minds it that you may have to do it a few times for these complex things to sink in, but you need to be very careful that you're not suddenly repurposing a trans space into a cis space when doing so.

But this is the question - is this a trans space? I am very, very careful to avoid spaces that are specifically for an identity not mine, regardless of the group in question - because I know that those things are not for me. But this isn't a transgroup, or a trans-only discussion - this is a general discussion, on Metafilter, that happens to be about trans issues. Metafilter is, as far as I understand it, a space for trans and cis alike. It isn't a trans space or a cis space. It is a diverse community space. And so you get to comment and talk from your perspective, and I mine, and a host of other people on theirs - but it's not for any one person or group.
posted by corb at 12:29 PM on May 28, 2013 [2 favorites]

A thread like this isn't a dedicated trans* space, true. But none of these threads are required to be 101-level discourse every single time, either. There comes a point where yes, questions about basic stuff may be disruptive to other discussions happening. There comes a point where it becomes one's personal responsibility to not make everyone answer questions one has asked (and had answered) in previous threads on similar subjects.
posted by rtha at 12:40 PM on May 28, 2013 [4 favorites]

Why, rtha? At what point in history is it incumbent upon the reader to go read some literature before engaging in discussion on Metafilter?

If we start talking bonds and interest rates, and someone asks supernewbie-dumb question, they should get an answer, not mocked for knowing so little of the topic. At worst, if it's damned simple, just point them to a definition; if not simple, answer the damn question - even though interest rates have been common knowledge for several decades.

And if a teen in a small town in Nebraska, with no prior experience with cis issues, feels like weighing in, let's judge their communication on their apparent intent and expressed ideas, not their prior exposure that WE have mandated to be an essential prerequisite (yet somehow have forgotten to put in the FAQ).
posted by IAmBroom at 12:54 PM on May 28, 2013

Not "the reader." I'm specifically addressing people who come into threads on subjects they have encountered here before, and ask the same questions they have asked and had answered previously. I am very specifically addressing corb's stated difficulty with remembering certain kinds of information (something that I reckon is true for most of us): after a certain point, it must become incumbent on those participating to manage their own acknowledged difficulties with remembering things.
posted by rtha at 1:52 PM on May 28, 2013

I do think context really matters as well. A questioned, asked once, is a harmless inquiry; but a question, asked multiple times when an informed answer has been given on multiple occasions, can easily become a tool to threaten especially on issues of gender identity and sexual orientation. "How do you know you're trans?" might be fine, but "How do you know you're trans? How do you know you're trans? Okay, but how do you actually know you're trans? No, really, how do you know you're trans?" can be really threatening to some people.

Which isn't to say that corb is doing this with the intent to threaten, but it can certainly inadvertently dye topics with a certain status quo. Trans* people should not have to constantly defend or explain their gender identity even under a presumed "right to education" mantra, nor should they constantly have to discuss trans* issues in the context of cis people. As a gay man, I appreciate how Metafilter can discuss gay rights issues without constantly having to answer the same repeated basic factual questions by the same user or in the same topic, defend against "but what about the children" attacks in the form of questions, and so forth. I would feel intensely uncomfortable if we did have that type of dynamic here, so I feel like I need to express concerns as a member of the LGBT community when that happens to trans* topics.
posted by Conspire at 2:14 PM on May 28, 2013 [3 favorites]

I think it's probably time to take this discussion to Metafilter.
posted by Joe in Australia at 9:39 PM on May 28, 2013 [1 favorite]

The entire medical establishment in this area is set up to protect cis people first and help trans people second, and additional handwringing over trans people getting any kind of benefit of the doubt and access to basic care options is tremendously silly.

This is an extremely important point to remember for anybody who isn't trans, isn't perhaps that aware of what being a trans man or trans woman entails, that throughout transition you are constantly questioned about your gender identity, that you constantly do have to prove that what you are feeling is real, not a psychological disorder, a whim or fluke. Some of this is necessary to succesfully transition, or at least proscribe by the medical establishment that allows you to transition, some of it comes from those closest to you who want to be sure you are not going to hurt yourself with this, a lot of course from uninvolved third parties that are curious about or hostile to you.

Which is why this is so true:

A questioned, asked once, is a harmless inquiry; but a question, asked multiple times when an informed answer has been given on multiple occasions, can easily become a tool to threaten especially on issues of gender identity and sexual orientation.

Even innocent questions, or questions out of ignorance will therefore be more likely to be felt as attacks, but especially when they come from people who have asked the same questions earlier.

Now I do think we're slowly getting better at this, but I can see why for those people for whom this is not just an academic debate this isn't going quickly enough.
posted by MartinWisse at 4:04 AM on May 29, 2013 [1 favorite]

If we start talking bonds and interest rates, and someone asks supernewbie-dumb question, they should get an answer, not mocked for knowing so little of the topic. At worst, if it's damned simple, just point them to a definition; if not simple, answer the damn question - even though interest rates have been common knowledge for several decades.

trans* issues are far more personal, intensive and potentially intrusive to a trans* person than bonds and interest rates are to bankers tbqh so I'm really not feeling this comparison
posted by titus n. owl at 9:04 PM on June 11, 2013 [1 favorite]